Health insurance coverage and politics are intertwined. This dissertation will examine how voters respond when there are changes to health care policies, why state legislatures and state executives act to address health care workforce shortages, and how interest groups utilize the political system to effectively pass policies. Chapter 1 evaluates the effect of coverage expansion on voter participation. One of the recognized benefits of increased health coverage is that it leads to improved financial wellbeing for beneficiaries. With improved financial status individuals may be more likely to engage in activities that previously had access barriers. One potential barrier that health insurance may alleviate is the barrier to voting. This paper will address 1) whether improved health insurance coverage and availability of Medicaid creates the observed effects; 2) whether improved voting participation resulted following the expansions of health insurance coverage; and 3) whether there is a threshold at which coverage expansions no longer effect voting behavior. We examine two states, Massachusetts following the 2006 coverage expansions and Florida following the 2014 coverage expansions. Chapter 2 examines the political conditions necessary for states to act to increase home care worker wages. Home care workers are among the largest and fastest growing segments of low-wage workers. In many states home care workers earn near hourly minimum wage. Medicaid is the primary payer for long-term care services and services provided in the home and community settings by home care workers. Medicaid’s large share of the home care market implies that policy made by a state Medicaid program could have a significant effect on home care worker wages in the private market. In recent years, state legislatures have taken actions to increase the wages for home care workers in the Medicaid. We examined 48 attempted wage increases and 34 successful wage increases from 2013-2018 to determine what political factors increase the likelihood that a state will increase home care worker wages. Union membership in the state, females in the legislature, and more professional legislatures were associated with increases to home care worker wages. Chapter 3 evaluates the changing role of direct democracy in health policy using Medicaid expansion as a case study. From November 2017 through November 2018 four states voted to expand through ballot initiative and only one voted to expand Medicaid through the legislature. Why have states decided to use this method of policy making, instead of passing the law through the legislature and governor? Setting Medicaid eligibility through direct democracy represents a growing change in how health policy is made in states and how ballot initiatives are used to change health care programs. The four Medicaid expansions are representative of this shift in method of policy making and were a way to overcome legislative obstructions through the traditional policy processes in states. These ballot initiatives passed because Medicaid expansion is popular among voters, interest groups advocating for these changes were well organized and funded, and they utilized local and national organizations to influence voters.

Objective To generate a national multiple sclerosis (MS) prevalence estimate for the United States by applying a validated algorithm to multiple administrative health claims (AHC) datasets. Methods A validated algorithm was applied to private, military, and public AHC datasets to identify adult cases of MS between 2008 and 2010. In each dataset, we determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. We applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the United States cumulated over 3 years. We also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated our estimate to 2017. Results The estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000 (95% confidence interval [CI] 308.1–310.1), representing 727,344 cases. During the same time period, the MS prevalence was 450.1 per 100,000 (95% CI 448.1–451.6) for women and 159.7 (95% CI 158.7–160.6) for men (female:male ratio 2.8). The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group. A US north-south decreasing prevalence gradient was identified. The estimated MS prevalence is also presented for 2017. Conclusion The estimated US national MS prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists. Our rigorous algorithm-based approach to estimating prevalence is efficient and has the potential to be used for other chronic neurologic conditions.

This article offers a framework that allows for the simultaneous comparison of all sexual orientation–gender–race/ethnicity groups after controlling for characteristics. The analysis suggests that occupations matter in explaining earnings differences among groups. The article also displays the high magnitude of the gender wage gap in an intersectional framework. The sexual orientation wage premium of lesbians is quite small for blacks and much higher for Hispanics and Asians than for whites. For men, departing from the white heterosexual model involves a substantial punishment; the racial penalty is larger for heterosexuals whereas the sexual orientation penalty is greater for whites.

Using Harvey’s (2012) Spaces of Capital: Towards a Critical Geography and Sharp’s (2009) Geographies of Postcolonialism as theoretical approaches and Gordon’s (2008) Mapping Decline: St. Louis and the Fate of the American City as historical context, a graduate-level critical geography of urban higher education class conducts field observations of St. Louis’ uneven geographies, centering Ferguson as a point of departure. Our use of critical geography and postcolonialism within education are critiques of U.S. capital accumulation in urban spaces and frame how we analyzed our observations and geo- graphic information systems data. Specifically, we use the subaltern space of Canfield Apartments, where Michael Brown was executed on 9 August 2014 by a Ferguson Police Department officer as the central location. Through field notes of each student’s site visits, bus-riding experience, and GIS data, we aim to provide mixed-method results on spaces of resistance and public transportation access, parts of uneven geographic developments contributing to discourses of U.S. college accessibility in St. Louis.

Researchers point out that names are signals of cultural identity. I follow the classical measure of name foreignness and estimate effects of immigration restriction laws on child naming in the early twentieth century U.S. I find significant evidence that after the passage of immigration restriction laws, there was a particular decline in name foreignness among second-generation immigrant children whose parents were from more restricted countries. The results are robust to changes to samples and specifications, and the effects of immigration restriction laws on child naming were unlikely to be through other channels, such as parents' assimilation and selection on migration.

This study examines and compares shared time for same-sex and different-sex coresident couples using large, nationally representative data from the 2003-2016 American Time Use Survey (ATUS). We compare the total time same-sex couples and different-sex couples spend together, as well as for parents, the time they spend together with children, and for both parents and non-parents, the time they spend together with no one else present and the time they spend with others (excluding children). After controlling for demographic and socioeconomic characteristics of the couples, women in same-sex couples spend more time together, both alone and in total, than individuals in different-sex arrangements and men in same-sex couples, regardless of parenthood status. Women in same-sex relationships also spend a larger percentage of their total available time together than other couples, and the difference in time is not limited to any specific activity

We derive an inference method that works in differences-in-differences settings with few treated and many control groups in the presence of heteroskedasticity. As a leading example, we provide theoretical justification and empirical evidence that heteroskedasticity generated by variation in group sizes can invalidate existing inference methods, even in data sets with a large number of observations per group. In contrast, our inference method remains valid in this case. Our test can also be combined with feasible generalized least squares, providing a safeguard against misspecification of the serial correlation.

Cross-country differences in homeownership rates are large and persistent over time, with homeownership rates ranging from 40% in Switzerland to 80% in Spain. This paper investigates whether culture is a driving factor of the homeownership decision, and could thus explain part of the cross-country differences in homeownership rates. To isolate the effect of cultural preferences regarding homeownership from the impact of institutions and economic factors, we investigate the homeownership decisions of second-generation immigrants in the United States between 1994 and 2017. Our findings indicate that cultural preferences for homeownership are persistent, transmitted between generations, and substantially influence the rent-versus-buy decision

The necessity of freshwater for sustaining human life has prompted the development of numerous estimation techniques and metrics for understanding where, when, and why water is used. While estimates are valuable, techniques for estimating water use vary, and may be difficult to replicate and/or unavailable on an annual basis or at the regional scale. To address these drawbacks, this paper proposes a series of regional indices for the continental United States that could serve as proxies for water use that are based on key variables associated with water use. Regional indices at the county level are computed, compared against each other, and compared to water withdrawal estimates from the United States Geological Survey (USGS). These comparisons highlight differences amongst the derived indices and the water withdrawal estimates. They also demonstrate promise for future development and implementation of related indices, given their similarities with water withdrawal estimates. Using only a small set of variables, these indices achieve some degree of similarity (~20%) to estimates of water withdrawals. The comparative data availability and ease of estimating these indices, as well as the ability to decompose the additive indices into their constituent use categories and constituent variables, renders them practically useful to water managers and other decision makers for identification of locally specific drivers of water use and implementation of more geographically-appropriate policies to manage scarce water resources.

We use the American Community Survey (ACS) to investigate the extent to which college major decisions were affected during and after the Great Recession with special attention to business and science, technology, engineering, and mathematics (STEM) fields, as well as the heterogeneity across demographic groups. Several conclusions are reached. First, the Great Recession increased the frequency of STEM majors but decreased the frequency of business majors. Second, the increase for STEM fields spreads across several detailed STEM majors, while the decrease in business majors is especially concentrated among finance and management. Third, we find strong heterogeneous effects of the Great Recession by gender and race/ethnicity. (JEL I20, J24).

This paper studies the impact of railroads on growth and structural transformation in 19th-century Sweden. To establish causality, the analysis exploits that the main state-owned lines of the network traversed rural communities that were not directly targeted by planners. Areas “accidentally” traversed by one of these trunk lines experienced substantially more rapid population growth and structural transformation over the next 50 years. These findings suggest that investments in transportation networks can spur industrial development and that the railroad is an important factor to account for Sweden’s rapid catch-up with the leading European industrializers.

This dissertation consists of three distinct, publishable `papers' included as sepa- rate chapters. The ?rst article looks at the Optional Practical Training (OPT) program which provides all foreign students on an F-1 education visa, legal, temporary work permit for 12 months after graduation. In 2008, students in the Science, Technology, Engi- neering and, Mathematics (STEM) ?elds became eligible for a 17-months extension of OPT period. This paper examines the impact of this extension on the labor mar- ket outcomes of domestic STEM graduates.Using a di?erence-in-di?erence framework with individual and time ?xed e?ects, we ?nd no reduction in the annual salary of domestic STEM majors after the policy was implemented. We ?nd a statistically signi?cant negative impact of the policy on the typical hours worked in a week. The results are driven largely by Master's level students and are robust to alternative speci?cations. Thus, we conclude that the OPT extension does not negatively im- pact labor market outcomes for domestic STEM graduates. Any di?erential impact of the STEM OPT extension is limited to a reduction in the typical hours worked during a week by STEM graduates. The second article develops a politico-economic model of native preferences over illegal immigrants. In a referendum like scenario, native agents who may be high or low-skilled and belong to three generations vote on whether to grant amnesty to illegal immigrants or support no change in their immigration status. Individual choices are aggregated to form the collective policy response, using majority-rule. In doing so, the article shows that economic incentives are driving the political impasse on a policy on illegal immigrants. If there were a vote on illegal immigrants, all generations of high-skilled agents vote against amnesty on account of the increased tax burden which are determined by a Utilitarian government. Low-skilled workers prefer amnesty as it increases the transfers received by them. The gains from additional transfers more than enough compensate for the loss in wages for the low-skilled. Finally, the article shows that an increase in the consumption tax rate can generate welfare gains for a majority of agents in the amnesty steady state and thus break the policy impasse on illegal immigration. The third article presents a model of the choice between migrating legally or illegally for a potential migrant. We employ a discrete choice dynamic programming framework to model this initial decision of the migrant and the model is calibrated on US data from the Legalized Population Survey I (LPS I) 1988-89, and the Current Population Survey (CPS) 1990. Holding the up-front cost of either immigration routes constant, the model predicts that the choice is not motivated by the desire to enjoy government transfers in the immigrant-receiving country. The key components in the choice are the fraction of legal wages received by illegal immigrants and the probability of being identi?ed and deported.

Hepatitis C treatment has rapidly evolved with the arrival of direct-acting antiviral therapy. Sustained virologic response (SVR) rates in clinical trials are high but it is unknown how this translates to the immigrant community. Data from December 2013 to September 2015 was collected from a Midwest academic and community practice with a large immigrant population. There were 802 patients with an overall SVR rate of 88%. Ledipasvir/sofosbuvir was associated with favorable response among genotype 1 and 4 patients compared to other regimens (p < 0.001 and p = 0.05). Factors associated with treatment failure included advanced liver disease, male gender, East African/Middle Eastern ethnicity, and non-compliance. Patients with genotype 4 had lower SVR rates than other genotypes (58% vs. 89%, p < 0.001), particularly among East Africans (40% vs. 82% for other ethnicities). Our SVR rate for genotype 4 infection is lower than clinical trials and may be related to cultural, biologic and socioeconomic factors.

We explore the decline in teen employment in the United States since 2000, which was sharpest for 16-17 year-olds. We consider three main explanatory factors: a rising minimum wage that could reduce employment opportunities for teens and potentially increase the value of investing in schooling; rising returns to schooling; and increasing competition from immigrants that, like the minimum wage, could reduce employment opportunities and possibly also raise the returns to human capital investment. We find that, among these factors, higher minimum wages are the predominant factor explaining changes in the schooling and workforce behavior of 16-17 year-olds since 2000. The employment decline arises from a combination of a lower likelihood of being both employed and enrolled in school, and a higher likelihood of being enrolled in school only (not employed). These effects are consistent with the minimum wage leading students to increase their focus on schooling to meet a higher productivity standard for jobs with a higher minimum wage.

Scholars have identified racially-integrated residential communities in all major regions of the nation; however, research has yet to investigate the downstream impacts of residential integration on institutional integration. In this paper, I ask whether stably-integrated places also contain similarly integrated schools. To address this question, I calculate the information theory index to investigate multigroup evenness among metropolitan Census Places using panel data on racial composition over the 2000 and 2010 Censuses. I link racially-integrated places to individual school racial and ethnic compositions. I hypothesize that integrated places will host exceptionally diverse public schools and will support larger white student populations than less integrated/more segregated settings.

Identification of same-sex couples in the American Time Use Survey (ATUS) is of increasing interest to the research community. While the ATUS surveys one person per household, using information about who else lives in the household, researchers can easily identify respondents in co-resident same-sex couple arrangements. Previous research has outlined two approaches to identifying same-sex couples in the ATUS that use information on the sex of household members. We extend that work by using additional information collected from a direct question to identify unmarried partners in the CPS. We identify 25% more cohabiting same-sex couples when we use the CPS direct question information than when we use information from the ATUS alone. We argue that our additional identification strategy is more inclusive of same-sex cohabiting relationships

This paper develops and calibrates a model of human capital investment in a frictional labor market with two-sided heterogeneity. The model generates underemployment in equilibrium: highly-educated workers are employed in jobs that do not require human capital to be productive. The decentralized equilibrium is never constrained efficient and can exhibit an inefficiently low or high underemployment rate. The model is calibrated to the U.S. economy and used to perform counterfactual policy experiments by increasing education subsidies and student loan borrowing limits. Fully subsidizing education increases the supply of highly-educated workers, the underemployment rate, and welfare. These effects are the result of shifts in the composition of jobs, the types of workers who invest in education, and adjustments in the returns to education that is driven through an aggregate production technology that exhibits diminishing returns to labor.

This paper attempts to study the mid- and long-term economic effects that merit-based scholarship programs have on students and the labor market in terms of education and income. Using empirical methodology that was originally used in Medicaid expansion literature, I construct “simulated eligibility” and use this in three different reduced form regressions. I find that shifting from the government providing no financial assistance to providing full assistance results in an ambiguous effect on total personal income, an approximate 4% increase in people with at least some college education, and close to no effect on graduation rates.

The ability to speak English is an important part of immigrant assimilation in the United States. In contemporary politics there is a concern that although earlier waves of immigrants learned English, newer cohorts are doing so at lower rates. This brief uses U.S. Census data to answer this concern and show that English language acquisition rates have increased over the past 100 years. About 91 percent of immigrants in the United States between 1980 and 2010 reportedly spoke English compared with 86 percent who lived here from 1900 to 1930. While immigrants with different backgrounds are more or less likely to learn English than others, our analysis unambiguously shows that today’s immigrants are more likely to learn English than immigrants in the beginning of the last century.

What factors influence agenda setting behavior in state legislatures in the United States? Using the localized effects of climate change, we examine whether notable changes in temperature can raise the salience of the issue, thus encouraging a legislative response. To evaluate the behavior of individual legislators around climate policy, we utilize an original data set that includes geographic mapping of climate anomalies at the state legislative district level and incorporates individual, chamber, district, and state characteristics to predict climate bill sponsorship. Using a multilevel model that estimates climate change bill sponsorship among 25,000 legislators from 2011 to 2015, we find a robust relationship between temperature anomalies and bill sponsorship for Democratic members of state legislators while Republicans are unresponsive to such factors. Our data and methodological approach allow us to examine legislative action on climate change beyond final policy passage and offers an opportunity to understand the motivations behind climate innovation in the American states.